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[y#11094K Due By April 25, 2008 as 2007 YEARLY FINANCIAL STATEMENT cr 7a THOMAS 1 HONGEAO 0 WEAVER HILL ROAD COVENTRY RI 02816- L ALL QUESTIONS REFER TO THE CALENDAR YEAR JANUARY 1, 2007 THROUGH DECEMBER 31, 2007 UNLESS OTHERWISE SPECIFIED. PLEASE ANSWER ALL QUESTIONS AND WHERE YOUR ANSWER IS “NONE” OR “NOT APPLICABLE” SO STATE. ANSWERS SHOULD BE PRINTED OR TYPED, and additional sheets may be used if more space is needed. For clarification of any question, read instruction sheet. Note: if you are a state or municipal official or employee that is required to file a Yearly Financial Statement, @ allure to fle the ‘Siatement is a violation ofthe law and may subject you to substantial penalties, including fines. If you recelved a 2007 Year- ly Financial Statement in the mail but believe you did nat hold a public position in 2007 or 2008 that requires such filing, you should contact the Ethics Commission (See Instruction Sheet for contact information). 1. monGeru Thomas He. aa OF OFFER Tasty co Taras 2 770 WenveR Hite Ro Coventéy AZT 0286 om ORES REET Tefen a cay SAME THAIN ADDRESS (i aifarnt Wa Foe Sar] 3, List Public Position(s) you hold and governmental unit Etecurive precwe- RI Susrice Commissiow osuieraso ‘HURIERLIY, STATE ON REGINA ‘PUBS POSTIORT ‘RRA BRE CH REST Iwas elected on. was appointed on 5/200 | was hired on aay eas Tas Ifyou no longer hold a public position, state date of termination or resignation AIA _ 4, List elected office(s) for which you werelare a candidate in either calendar year 2007 or 2008 (Read instruction #4) W/h 5. List the following: NAME OF SPOUSE NAME(S) OF DEPENDENT CHILD OR CHILDREN Cywrtia Po ManceAd TJEssich. M. MOUGEAY 6. List the names of any employer from which you, your spouse, or dependent child received $1,000 or more gross income during calendar year 2007. Ifsetf-employed, list any occupation from which $1,000 or more gross income was received. if employed by a state or municipal agency, or if self-employed and services were rendered to a state or municipal agency for an amount of income in excess of $250, list the date and nature of services rendered. ifthe public position or employment listed in #3, above, provides you with an amount of gross income in excess of $250 it must be listed here. (Do Not List Amounts.) sue oF avauy awe ano aopRess OnTES ano waTuRe wae Ae oF en OVEN OR OOSUPATION oF SERN RENDERED Cyuriia F Modena Coveney chevir palin Lops SERVICES ig) CONeeT ey jor — 12x07 a) Sxecure Ddieectar Thomas Movliete Br eS ec afer = teaser peovivence PL 7. List the address or legal description of any real estate, other than your principal residence, in which you, your spouse, ‘or dependent child had a financial interest. NAMES NATURE OF INTEREST ADDRESS OR DESCRIPTION Tomas € cystih Tue shake Pounrn Besok ResoeT MeN GEnn Linconw, WH 8. Listthe name of any trust, name and address of the trustee of any trust, from which you, your spouse, or dependent child or children individually received $1,000 or more gross income. List assets if known. (Do Not List Amounts.) vwcor rust: V/A ee —“—SSS=sSCOCO_ONONNN ~— nawcorcame wm AA ASSETS: _ _ 9. Ust the name and address of any business, profit or non-profit, in which you, your spouse, or dependent child held @ position as a director, officer, partner, trustee, or a management positon. NAME OF FAMILY MEMBER, NAME AND ADDRESS OF BUSINESS POSITION Wh 10. List the name and address of any interested person, or business entity, that made total gifts or total contribu- tions in excess of $100 in cash or property during calendar year 2007 to you, your spouse, or dependent child. Certain gifts from relatives and certain campaign contributions are excluded. (See instruction #10) NAME AND ADDRESS OF PERSON ORENTITY NAME OF PERSON RECEIVING GIFTOR CONTRIBUTION MAKING GIFT OR CONTRIBUTION, A/a 11. List the name and address of any business in which you, your spouse, or dependent child individually or collectively holds a 10% or greater ownership interest, or a $5,000 or greater ownership or investment interest. NAME OF FAMILY MEMBER BUSVESS ane Exrow MIBic conf. x wicker Therids. $ CysTHA PONGERA Generar ELECTRIC. t PEPSI Co, — CEs THAN T80 ANMEUSER BUSH Less Home DELOT — Les THA en MERCK Co —cass THe © 12. If any business listed in #11, above, did business in excess of a total of $250 in calendar year 2007 with a state or municipal agency, AND you are a member or employee of the agency or exercise direct or legislative control over the agency, list the following: NAME AND ADDRESS NAME OF AGENCY DATE AND NATURE: ‘OF BUSINESS ‘OF TRANSACTION La 13. If any business listed in #11, above, was a business entity subject to direct regulation by a state or municipal agency, AND you are a member or employee of the agency or exercise direct or legislative control over the ist the following: agency, [NAME AND ADDRESS OF BUSINESS NAME OF REGULATING AGENCY Mh